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Applicant Information
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Last
Address
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*
DUNS Number
Property Information
Contact Person
First
Last
Address of Building to be rehabilitated
Street Address
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Home Phone Number
Cell Phone Number
Work Phone Number
Email
Preferred Method of Contact
Home Phone
Cell Phone
Work Phone
Email
Age of Building
Existing Building Use
General Description of Building
Is the building on the National Historic Register?
Yes
No
Ownership Information
Ownership interest in property to be improved
Contract for Deed
Outstanding Mortgages
Free and Clear
Lessee
Other
Specify Term of Lease
Specify
Names on Title
Specify ownership interest of each name on the title.
Amount of Outstanding Principal owed on Building
PLEASE ATTACH A COPY OF THE MOST RECENT PROPERTY TAX STATEMENT FROM THE COUNTY ASSESSOR'S OFFICE.
Accepted file types: jpg, gif, png, pdf, Max. file size: 50 MB.
Proposed Project Information
Your description of the scope of the project
Number of Existing Jobs
Number of Jobs Created
Total Number of Jobs
Exterior Improvements
Signage
Awning
Interior Improvements
Your best estimate of the total project cost
Resources to be Utilized for Private Match of Funds
Personal Savings
Mortgage
Private Loan
Other
Please Specify if Other
I certify to the best of knowledge that the information contained herein is complete and accurate. I authorize representatives of the Southeast Minnesota Multi-County Housing and Rehabilitation Authority and City the right to access the property to be improved for the purpose of the deferred loan and mortgage program.
Name
First
Last
Date
MM slash DD slash YYYY
NOTE: ALL NAMES AND FINANCIAL INFORMATION PROVIDED ON THIS APPLICATION ARE CONSIDERED PRIVATE DATA ON INDIVIDUALS AND ARE SUBJECT OF PRIVACY OF INFORMATION PROVISIONS, PURSUANT TO STATE STATUTE.
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